With the recent upgrade of the MRI system, it has become possible to use 3D arterial spin labeling (3D ASL), which is an MR perfusion imaging technique without use of any contrast material. In this paper, we report the effects of imaging conditions on the cerebral blood flow (CBF) level (the amount of cerebral blood flow per unit brain tissue〔ml/min・100g〕) . We also report our clinical experience with 3DASL. In respect of the imaging conditions, changes in CBF values were examined when the arm and the number of excitations (NEX) were variable. The results showed that there were no significant differences in CBF values between different regions in the brain. This was due probably to the fact that the spin of the labeled blood was unaffected although the arm influenced the spatial resolution of images and NEX affected SN ratio.

The collagen gel droplet-embedded culture drug sensitivity test (CD-DST) identifies effective anticancer drug using resected tumor specimen, enabling tailor-made chemotherapy for a rare tumor. We report a case of the patient with leiomyosarcoma originating in the inferior vena cava, to which CD-DST was applied. This application has not been previously reported to the best of our knowledge. A 61-year-old woman consulted a nearby hospital because of abdominal pain. Computed tomography revealed an inferior vena cava tumor. The tumor was resected with the inferior vena cava, which was reconstructed with a 16 mm ePTFE graft. The tumor was diagnosed as leiomyosarcoma histopathologically. CDDP, VP-16, ADR, and VDS were CD-DST showed the tumor to be sensitive. Her postoperative course has been good without recurrence of tumor for 6 months, and the results of CD-DST may be helpful for chemotherapy strategy in case of recurrence.

Palliative care team（PCT）, nutrition support team（NST）and office of nutrition in our hospital developed a special soup service, which was served for ten patients faced with terminal cancer. The members of PCT, NST and the Cook served a special soup to ten patients. Nine of them could taste the soup without vomiting although they had anorexia. It was a good result. The number of days from the last day tasting the soup to death or hospital transfer was between 3 and 20 days（12.5 days on average）, and the number of times they could taste the soup was between 1 and 3（2.0 times on average）. Tasting the soup supports the strength of living, and might bring an improvement in spiritual quality of life.

An inflammatory fibroid polyp (IFP) is a mesenchymal tumor of the gastrointestinal tract. IFPs in the small intestine are the most frequently detected with symptoms, such as abdominal pain and tarry stool due to intussusception. Accordingly, few studies have reported jejunal IFP as a cause of occult gastrointestinal bleeding (OGIB) diagnosed via both of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). A 68-year-old woman presented with a progression of anemia and a positive fecal occult blood test result. Esophagogastroduodenoscopy and total colonoscopy findings were unremarkable. CE revealed a tumor with bleeding in the jejunum. DBE also revealed a jejunal polypoid tumor. Bleeding from the tumor seemed to have caused anemia. The patient underwent partial laparoscopic resection of the jejunum, including resection of the tumor. The tumor was histopathologically diagnosed as IFP. To our knowledge, this is the first reported case of laparoscopic resection of jejunal IFP with OGIB diagnosed via CE and DBE preoperatively.
Abdominal Pain ; Aged ; Anemia ; Capsule Endoscopy* ; Colonoscopy ; Double-Balloon Enteroscopy* ; Endoscopy, Digestive System ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Intestine, Small ; Intussusception ; Jejunum ; Laparoscopy ; Leiomyoma* ; Occult Blood ; Polyps*

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

An 83-year-old man who had undergone aortic arch repair using the elephant trunk technique in addition to abdominal aorta repair required surgical intervention for a pseudoaneurysm at the distal anastomosis of the aortic arch graft. Due to marked adhesion around the aneurysm, aortic cross-clamping was not feasible. Thus, under femoro-femoral partial bypass, the arch prosthesis was endoclamped using an aortic occlusion balloon inserted through the left femoral artery into the aortic arch graft and through the elephant trunk, guided by fluoroscopy and transesophageal echocardiography. This allowed descending aorta replacement with minimal bleeding. His postoperative course was uneventful. This technique enabled safe and bloodless clamping of the proximal portion of the aortic arch graft.